"I have a cough that's getting out of hand; I've been getting short of breath; and my ankle keeps swelling," Joe rattled off his list of troubles raising a finger for each one.
"Does the shortness of breath come after heavy exertion?" Dr. Bates asked, holding the head of his stethoscope in his hand to warm it up before he put it to Joe's chest.
"Sometimes," Joe answered looking at the doctor from his position on the examining table and not seeing the deepening look of concern on his father's face. "Lately, I even get winded just going from one floor of the school to the next."
Dr. Bates put the instrument to Joe's chest as Joe erupted into a fit of coughing. "Well, I guess I won't have to ask you to cough, will I?" Dr. Bates asked with a smile that never quite reached his eyes after Joe had finished. "Now that we did that part, how about taking a deep breath?"
When he was finished listening to Joe's chest he stepped back. "He's hurt his ankle as well," Fenton said as the doctor got a tongue depressor to check Joe's throat.
"Yeah," Joe picked up. "It was swollen last night but it went away and came back this afternoon."
"Anything else wrong?" Dr. Bates asked, stopping in front of Joe with the tongue depressor ready. "Insatiable thirst? Pain?"
"No thirst," Joe answered. "But I did have a sharp pain kind of streak across my chest this afternoon when I couldn't catch my breath."
"Can you show me where?" asked Dr. Bates. Joe made a motion near his heart from the left to the right. "Have you felt that kind of pain before?"
"No," Joe answered.
"Let's finish your check up and then I want to get an X-ray of your ankle," Dr. Bates said. "Open up and say ahh."
"Joe, if you'll go with Nurse Wilkinson she will take an X-ray of your ankle," Dr. Bates said, smiling at Joe as the woman walked into the room. "Fenton, a word?" he asked as Fenton started to follow Joe from the room.
"What's wrong?" asked Fenton. The doctor's regressive countenance had not gone unnoticed during Joe's check-up.
"I want the X-ray to rule out any possibility of a sprain," Dr. Bates said.
"You don't think it's an injury?" queried Fenton. "But why would his ankle swell?"
"Fenton, sit down," Dr, Bates requested.
His heart rate picking up speed, Fenton did as he had been bidden. "Joe's symptoms, coupled with my exam thus far, lead me to believe that there may be something seriously wrong with him."
"What?" demanded Fenton, his brown eyes horror stricken.
"I'm not sure," Dr. Bates replied. "But I want to admit him to Bayport General for an electrocardiogram and some other tests."
"He's only seventeen!" Fenton objected. "And he's always been in great health."
"Until he had rheumatic fever last summer," Dr. Bates corrected him. "Joe's developed a heart murmur," he explained. "That in itself is cause for some concern but most people don't have problems with it and those that do generally wait until they are much older."
"But?" prompted Fenton.
"But all the symptoms Joe is experiencing can be chalked up to heart disease," stated Dr. Bates.